How To Check If Trauma Therapy Has Been Successful

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Elsewhere on this site, we have looked at what memory reconsolidation is and the steps needed for the brain to do it.

We have looked at ways of identifying the core predictions that need to be mismatched, and some possible approaches for creating a mismatch experience.

It is important to note that the approaches used are just examples of how to trigger memory reconsolidation. They are not memory reconsolidation itself.

Memory reconsolidation is the destination. The approaches, techniques and methodologies are merely the vehicles that get us there – so long as they follow the map.

There are likely an infinite number of approaches that can trigger memory reconsolidation.

But how do we check whether such change has occurred? How can you verify that memory reconsolidation has taken place as you hoped?

How Memory Reconsolidation Is Different

There are clear markers of change that distinguish memory reconsolidation from other kinds of improvement. Memory reconsolidation is not counteractive change. It does not leave the trauma intact with some additional new options.

Instead, it erases the trauma that you have been working on so it is gone for good.

As such, change is not incremental. The client will not be a little better each time. They will not zig zag forward and back.

If memory reconsolidation has occurred, the change will be more sudden. Next time you see the client, the trauma response will be gone.

Three Outcomes

In this post, we will look at how to verify that this has occurred. There are typically three outcomes:

  1. The trauma response is gone. The problem they were struggling with is no longer an issue.
  2. The trauma response you were working on is gone. In its absence, verification reveals a separate trauma response that would still keep the problem alive.
  3. The problem remains.

OUTCOME 1: PROBLEM SOLVED

In the first instance, memory reconsolidation has taken place and the problem is resolved.

OUTCOME 2: SUCCESS AND MORE TO DO – JASON’S CASE

In the second instance, memory reconsolidation has taken place, but there are other target learnings to address. This involves looping back and working with these remaining core predictions in the same way.

Some problems do have multiple targets. So memory reconsolidation can be successful and still leave some work to do on a separate target.

For instance, think of Jason who stays in the background, missing opportunities in the process.

He senses that this is due to how his father criticised him as a young child. He doesn’t want to step forward in life now, as his nervous system expects that same threat. Despite its many costs, it feels safer to stay in the background.

We may find that, since our attempt at memory reconsolidation, there has been a huge shift and the old fear of his father is gone. But there is something that still remains.

Exploring it ultimately leads us to discover that, even without the criticism from his father, Jason fears being successful. His family expressed negative views about successful people, so to be successful is to be rejected by those he most needs.

Notice how, with this client, we could discover that memory reconsolidation has worked without yet solving the problem.

The work we were doing with his father has been accomplished. Yet Jason’s fear of being successful in life has not yet been addressed. It comes from a different target, and we need to loop back and work on this as a separate issue.

OUTCOME 3: NO MEMORY RECONSOLIDATION TOOK PLACE

In the third instance, it didn’t work. So you need to keep going. Loop back to see if you had the right target learning. Maybe you need to generate a different mismatch experience to reconsolidate the trauma.

Before making a decision about which of these three outcomes occurred, we need a way to test if memory reconsolidation successfully took place or not.

BOOKENDING THE OPENING SESSIONS

When we verify memory reconsolidation work, we return to the information gathered during the opening stages of therapy.

You will recall that, when identifying the problem, we found some important information to help us move forward in our work.

We discovered:

  • The problem itself
  • Examples of how the problem shows up situationally
  • How that feels in the body/nervous system in those moments
  • What the desired outcome is instead
  • How the problem situations would look different when our work is done
  • How the nervous system mobilises against the client to stop them getting their desired outcome

This information helps us during the verification phase of the work.

We already know what the client wants. We know their desired outcome and what that looks like.

We know how their nervous system reacts to the problem situations. We know how their nervous system reacts when they attempt to get what they want.

We also have a collection of example scenes that trigger the client’s problem.

We are able to use this information to check whether the change occurred.

A Six POINT Verification Road Map

Below is a road map of what to check in order to verify the success of your memory reconsolidation work.

  1. Check the triggering situations where the problem shows up
  2. Check future imaginal scenes that would previously be triggering
  3. Check the activating scene that we used in the imaginal work
  4. Check other triggering scenes that have been mentioned during therapy
  5. Check the target learning explicit statement
  6. Check the desired outcome

THE key role of the NERVOUS SYSTEM

With each of these six checkpoints, keep a special watch on the nervous system.

The nervous system doesn’t lie. Most of us can get temporary change with a little willpower. Think of how the gyms fill up every January as people briefly enact their New Year’s Resolutions. Then check the same gyms in February to find them empty once more.

We are not looking for a change that might involve willpower. Change that requires willpower implies that the barrier to change still exists, so we fought to power through it.

The kind of change that occurs with memory reconsolidation is easy. Willpower is not needed. The trauma response that stood in the way of change is gone. There is no need to power through. Indeed, there is nothing there anymore to power through.

By checking the nervous system responses, we are getting a truthful picture. The nervous system acts independently of us. When a scary part happens in a movie, you jump – except YOU don’t jump at all. Your nervous system jumps you. It is a body hijack beyond your decision making.

These body hijacks are part of our inbuilt protection mechanism. They are predictions designed to keep us safe.

But when they are based on outdated information, they need to be updated. By checking the nervous system response directly, we are able to know whether the original core prediction is still active, or whether a new one has been successfully installed.

How to check the nervous system

The easiest way to check the nervous system is by inviting the client to focus on what is happening in the body.

As we make each of the six checks, we can ask the client to notice what bodily responses occur for them.

Much of this verification work is imaginal and experiential, as is a lot of memory reconsolidation work.

We don’t want them to logically think about a scene that would have previously been triggering. We want them to step into it. This is more activating and will give us more evidence of its erasure.

The client will know very quickly whether

A) it feels fine,
B) there has been a shift but something still remains that needs more work,
C) the old stuff is there as strong as ever.

THE SIX CHECKS

Let’s go through each of the six checks in detail:

  1. Check the triggering situations where the problem shows up
  2. Check future imaginal scenes that would previously be triggering
  3. Check the activating scene that we used in the imaginal work
  4. Check other triggering scenes that have been mentioned during therapy
  5. Check the target learning explicit statement
  6. Check the desired outcome

1. PROBLEM SITUATIONS

In the opening sessions, we sought examples of where the problem shows up and what it looks like.

For example, Reg struggles with boundaries. There are so many occasions where he wants to say no but doesn’t. He feels anxious a lot of the time as he feels so out of control in life.

In the opening sessions he gave examples of when this shows up:

  • at work when a colleague asks him to swap shifts,
  • at home when his partner decides on a vacation that he knows he will hate,
  • with friends when discussing the restaurant to eat at, and he stays silent despite having a clear preference.

These are tangible examples of the problem as it showed up in Reg’s life.

You can now experientially check in with these old scenes. Again, I am trying my best to activate the old triggers. It is only once I have fully tested them and got no response that I feel confident that it has successfully worked.

Also, if some other response is present that is tied to a slightly different target, I want to catch that too. We can then work on that newly-identified nervous system response going forward – as with Jason earlier.

We can use life itself to check how these situations have shown up since we last met.

Therapist: So Reg, I know that this problem would show up in a few places. People would ask you something and you wouldn’t say no or state your own preference. Have you noticed yourself in any of those situations at all?

Client: Yes. Mark asked me to swap shifts again and I didn’t want to.

Therapist: How did it go?

Client (matter of fact): I just told him no.

Therapist: You told him no? Wow. How was that for you?

Client: It was easy. I didn’t want to do it so I said no.

Therapist: Okay great. And what happened in your body as it was happening?

Client: I was just calm. I didn’t want to change shifts. I would have had to cancel badminton so I just said no. I don’t suppose I really thought about it.

Therapist: What about the butterflies that normally show up?

Client: No they weren’t there.

Therapist: The weight in your chest?

Client: No it was fine.

Therapist: How about the blushing. You mentioned that you always blush during these things.

Client (laughs): Yes I actually didn’t blush. Wow, I’d not realised that. But no, I didn’t blush. I hate blushing. It feels like I’m showing my weakness. But no. No blushing.

Notice how Reg is very matter of fact. It’s not a struggle. He’s not powering through difficult feelings like a tug of war. It feels easy. This is a clear marker that memory reconsolidation has successfully occurred.

Notice too how checking on the nervous system responses uncovers evidence that can’t be forced. People who blush try their very best not to blush. Yet that only makes it worse.

The absence of those involuntary nervous system responses like blushing is great evidence that memory reconsolidation has occurred.

2. IMAGINED FUTURE SCENES

We can make similar checks using imaginal experiences. These involve inviting the client to be inside situations that would usually be triggering.

Therapist: So has your wife talked about next year’s vacation since we met?

Client: No that’s not come up.

Therapist: Okay, so let’s just fast forward to it coming up. Close your eyes and put yourself in that scene. There she is and she brings in a holiday brochure and starts telling you about the vacation she’s thinking of. It’s a vacation you really don’t want to go on, the kind you’d hate. Be in it for a moment and notice what comes up.

Client: It feels fine. I’m just thinking that I’m not going there.

Therapist: And are you saying that or just thinking it.

Client: No, I’m saying it. I’m saying “I don’t want to go there. I wouldn’t enjoy that.”

Therapist: And how is that for you? What’s happening in your body? Check in with it a moment.

Client: Yeah it feels fine. I don’t want to go so I’m just telling her that.

Again, the client is immersed in a previously triggering scene that now has a “no big deal” quality to it.

3. THE IMAGINAL ACTIVATING SCENE

If you have done an imaginal re-enactment of an old distressing scene, this is great source material. You can use that same scene to verify whether memory reconsolidation has taken place.

Simply invite the client to put their attention on the original distressing scene.

Therapist: So last time we had a do-over of the scene with you and Dad.

Client: Yes.

Therapist: So, if you’re ok to, just place your attention and your memory back on the original scene as it originally happened. Notice what comes up for you as you place your attention there.

Client (after a short time): I’m not feeling anything really.

Therapist: When you say you’re not feeling anything, check in with yourself. Does that “not feeling anything” feel numb, or does it feel neutral?

Client: Yeah it feels neutral. I mean, I’m looking at the original scene and I can remember it fine. But I don’t feel any distress or anything like that.

4. OTHER TRIGGERING SCENES

At the start of therapy, you will have invited the client to share some situational examples of the problem.

As therapy continues, they will often share other triggering scenes that show up in life.

You can use some of these scenes to check out their new nervous system responses to them.

Therapist: So I’m remembering a time a few months ago, when your boss unexpectedly called you in for a meeting. Do you remember?

Client: I’m not sure.

Therapist: It was morning around 11, and suddenly you got an email saying she wanted to see you at 3.

Client: Oh yes. I remember.

Therapist: Let’s fast forward and imagine that happens again. Close your eyes and experience the uncertainty and the anticipation around that meeting. What comes up?

Client: Well there’s some worry there I notice. I’m curious what she might want and if everything is okay. But I feel okay. I feel like I can hold that and just get on with my day.

Therapist: So this feels different from how it was last time?

Client: Oh yes, totally. I went to pieces last time. I couldn’t do a thing until the meeting came.

Therapist: So how is this different as you experience that now?

Client: Well I’m basically calm. I still have a bit of concern at what the meeting might be about. But I’m also curious too. Like maybe it’s a good thing. So I’m just carrying on and I’ll find out when I find out.

Therapist: And that concern you feel – where would you say it belongs? How much of it is tied to how Mum was and how much feels present day? What’s the percentage split?

Client: Oh no it feels present day. My boss wants to see me and so there’s some uncertainty and a bit of worry. It’s different to how it was last time.

5. CHECK THE SINGLE SENTENCE AND OTHER EXPLICIT STATEMENTS

Another check is to re-introduce explicit statements like the Single Sentence Statement.

A client, April, had a core prediction stated in this single sentence:

If I reach out to my friends when I am feeling down
They won’t respond because nobody truly cares about me
So I keep myself isolated in times of trouble
Even though I long to reach out and get support from my friends
Because ANYTHING is better than experiencing not being cared about

We can show this to her now and ask her to notice whether it feels true. Note that we are not asking whether it is logically true, but whether it FEELS true in the body.

We use the Single Sentence to check her current allegiance to the statement that was at the heart of her core prediction.

Therapist: So let’s check in with your statement. Take a moment and just tell me if this FEELS true. Not neck up but neck down. Don’t ask your brain, check in with your body.

April (laughs): No. To be honest it looks ridiculous.

Therapist: It does?

April: Yes. I don’t believe any of that now.

This is a common response after memory reconsolidation. The thing that once felt so deeply true is now rejected.

6. CHECK THE DESIRED OUTCOME

In the opening sessions of therapy, we invite the client to describe why they have decided to work with us. They typically describe the problem they want to deal with.

As mentioned earlier, I like to invite the client to describe their desired outcome. How will they know our work has been a success? What would they like to be happening in those moments instead?

April may say that she wants to be reaching out to friends when she is feeling blue.

During those opening sessions, I check April’s nervous system responses when she imagines doing just that.

Therapist: So put yourself in that situation briefly now. You’re feeling rotten and you notice you’d love some emotional support from your friend. Imagine yourself reaching for your phone and calling her number.

April: Ughh. No. I couldn’t.

Therapist: What happens in your body when you think of doing that?

April: I feel sick. My jaw tightens and my stomach flips.

Therapist: Keep checking your body. What else do you notice?

April: I feel a tightness in my chest and everything goes tense.

Therapist: Ok that makes sense. So your stomach flips, your jaw tightens, you feel sick and your chest feels tight and you notice a tension in your body generally?

April: Yes, that’s right.

This early description gave us important information. It showed us which bodily responses mobilise to prevent her from getting what she wants.

I invite April to revisit this same imaginal scene of reaching out to call her friend. This will tell us whether this previous response has now changed.

Therapist: So put yourself in that situation briefly now. You’re feeling rotten and you notice you’d love some emotional support from a friend. Imagine yourself reaching for your phone and calling her number.

April (after a short while): Yes that feels fine.

Therapist: What’s happening in your body as you imagine yourself doing that?

April: Relief really.

Therapist: Relief?

April: Yeah. I’m needing to talk to someone and so I do. So it feels nice. Like a relief.

Notice that this is a completely different nervous system response. There is no longer a nervous system response mobilised against her. Memory reconsolidation has overwritten the old prediction of threat.

SUMMARY

Verification is a deeply important part of memory reconsolidation work. We need to know whether memory reconsolidation has taken place. If it has, it will be effortless for the client, and the effects will be permanent. If it has not, we must loop back and see what additional reconsolidation work is needed.

Using these six checks give us a chance to reactivate the old trauma response. If it is still there, it will show up.

We try to prove that memory reconsolidation did not take place.

I sometimes think of this as almost poking the old response with a stick to get a response from it. The hope is that the trauma response is no longer there.

If it is, it will show itself quickly, so pull back and work more gently. Otherwise, keep trying to prove that the trauma response is still present. Let its absence demonstrate that it is not.

If memory reconsolidation has indeed taken place, then there will be two outcomes:

  1. The problem is gone
  2. The trauma response you worked on is gone but, like with Jason’s fear of success, there is another target still to work on.

Some of these dialogues may seem too good to be true on first reading. But this is what it is like for clients who no longer have this trauma response.

Memory reconsolidation has removed that response, so it is no longer there. They are now living life as if the trauma had never occurred, even though they still recall the original events.

Think of having the same conversations with someone who never experienced that trauma at all. None of these conversations would seem outlandish with them.

When memory reconsolidation occurs for clients, they too are without that trauma response.

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